Is yoga effective in reducing symptoms of multiple sclerosis?
Data of publication of the systematic review: November 2014
Design
Systematic review of 7 randomized controlled trials (RCTs).
Participants
A total of 670 adult participants (mean age range: 31.6 to 54.4 years, overall male % range: 0 to 24.8%) who were diagnosed with multiple sclerosis (MS) were included.
Intervention
2 specific type of yoga interventions were used which is Hatha yoga (3/7) and Iyengar yoga (1/7). 2 studies let the teacher decide on the yoga style and 1 did not report the style. Length of intervention ranged from 8 weeks to 6 months. Frequency ranged from 1 to 3 times per week. Duration ranged from 60 to 90 minutes.
Comparator
Comparison 1: Yoga versus usual care;
Comparison 2: Yoga versus exercise.
Major Outcomes
Outcome 1: Health-related quality of life, measured by Multiple Sclerosis Impact Scale, Multiple Sclerosis Quality of Life Scale or generic instrument. Higher scores indicated worse health-related quality of life;
Outcome 2: Fatigue level, measured by Fatigue Severity Scale or the Modified Fatigue Impact Scale. Higher scores indicated higher fatigue level;
Outcome 3: Mobility, measured by 6-minute walk test. Higher scores indicated better mobility.
Settings
The reviewers did not state whether the study was conducted in in-patient or out-patient settings.
Comparison    Yoga versus usual care
Main Results
Compared to usual care, yoga is effective in reducing fatigue level (pooled SMD: -0.52, 95% CI: -1.02 to -0.02) among patients with MS. But the effect of yoga is insignificant for improving health-related quality of life (pooled SMD: 0.06, 95% CI: -0.19 to 0.30) and mobility (pooled SMD: -0.20, 95% CI: -0.69 to 0.30).
Comparison 1: Yoga versus usual care among patients with MS
Outcomes No. of studies (Total no. of participants) Mean score / No. of participants Heterogeneity test (I2) Pooled SMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 6 (263) Not reported/ 139 Not reported/ 124 0% 0.06 (-0.19 to 0.30) Moderate
2 5 (203) Not reported/ 109 Not reported/ 94 60% -0.52 (-1.02 to -0.02) Moderate
3 3 (63) Not reported/ 33 Not reported/ 30 0% -0.20 (-0.69 to 0.30) Moderate
Keys: SMD: standardized mean difference; CI: confidence interval.
Comparison    Yoga versus exercise
Main Results
Compared to exercise, the effect of yoga is not significantly better for improving health-related quality of life (pooled SMD: 0.09, 95% CI: -0.15 to 0.34), fatigue level (pooled SMD: 0.03, 95% CI: -0.24 to 0.30) and mobility (pooled SMD: -0.11, 95% CI: -0.63 to 0.41).
Comparison 2: Yoga versus exercise among patients with MS
Outcomes No. of studies (Total no. of participants) Mean score / No. of participants Heterogeneity test (I2) Pooled SMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 3 (328) Not reported/ 98 Not reported/ 230 0% 0.09 (-0.15 to 0.34) Moderate
2 6 (369) Not reported/ 119 Not reported/ 250 13% 0.03 (-0.24 to 0.30) Moderate
3 3 (59) Not reported/ 33 Not reported/ 26 0% -0.11 (-0.63 to 0.41) Moderate
Keys: SMD: standardized mean difference; CI: confidence interval.
Comparison    Yoga versus usual care
Main Results
Compared to usual care, yoga is effective in reducing fatigue level (pooled SMD: -0.52, 95% CI: -1.02 to -0.02) among patients with MS. But the effect of yoga is insignificant for improving health-related quality of life (pooled SMD: 0.06, 95% CI: -0.19 to 0.30) and mobility (pooled SMD: -0.20, 95% CI: -0.69 to 0.30).
Comparison 1: Yoga versus usual care among patients with MS
Outcomes 1 2 3
No. of studies (Total no. of participants) 6 (263) 5 (203) 3 (63)
Mean score / No. of participants Intervention Not reported/ 139 Not reported/ 109 Not reported/ 33
Comparator Not reported/ 124 Not reported/ 94 Not reported/ 30
Pooled SMD (95% CI) 0.06 (-0.19 to 0.30) -0.52 (-1.02 to -0.02) -0.20 (-0.69 to 0.30)
Overall quality of evidence* Moderate Moderate Moderate
Keys: SMD: standardized mean difference; CI: confidence interval.
Comparison    Yoga versus exercise
Main Results
Compared to exercise, the effect of yoga is not significantly better for improving health-related quality of life (pooled SMD: 0.09, 95% CI: -0.15 to 0.34), fatigue level (pooled SMD: 0.03, 95% CI: -0.24 to 0.30) and mobility (pooled SMD: -0.11, 95% CI: -0.63 to 0.41).
Comparison 2: Yoga versus exercise among patients with MS
Outcomes 1 2 3
No. of studies (Total no. of participants) 3 (328) 6 (369) 3 (59)
Mean score / No. of participants Intervention Not reported/ 98 Not reported/ 119 Not reported/ 33
Comparator Not reported/ 230 Not reported/ 250 Not reported/ 26
Pooled SMD (95% CI) 0.09 (-0.15 to 0.34) 0.03 (-0.24 to 0.30) -0.11 (-0.63 to 0.41)
Overall quality of evidence* Moderate Moderate Moderate
Keys: SMD: standardized mean difference; CI: confidence interval.
Conclusion
Benefits
Compared to usual care, yoga is significantly better in reducing fatigue level among patients with MS. Compared to exercise, yoga is not significantly more effective in reducing symptoms of MS. For all outcomes, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
An adverse event of exacerbation of sclerosis condition was reported.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/25390344
The synopsis is based on the following article:
Cramer H, Lauche R, Azizi H, Dobos G, Langhorst J. Yoga for multiple sclerosis: a systematic review and meta-analysis. PloS one. 2014 Nov 12;9(11):e112414.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.